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Deep cutaneous phaeohyphomycosis caused by Cladophialophora boppii: A case report

Summary

A 69-year-old woman with breast cancer developed a skin infection caused by a rare fungus called Cladophialophora boppii while taking dexamethasone for cancer treatment. Doctors diagnosed the infection through skin biopsy and fungal testing, then removed the infected area surgically. After three weeks of antifungal medication (itraconazole), the infection cleared completely and did not return during four months of follow-up. This case suggests that surgery combined with short-term antifungal treatment may be sufficient for this type of infection.

Background

Cladophialophora boppii is a dematiaceous fungus rarely causing cutaneous and respiratory infections with only four case reports detailing its cutaneous manifestations to date. Phaeohyphomycosis is a fungal infection caused by melanized fungi, encompassing approximately 70 genera and 150 species.

Objective

To present and analyze a case of deep cutaneous C. boppii infection in a 69-year-old patient with stage IV breast cancer on immunosuppressive therapy, and review diagnostic and therapeutic approaches for managing such infections.

Results

Sequence analysis confirmed 100% match with C. boppii type strain. Surgical excision followed by three-week itraconazole treatment (200 mg/day) led to infection resolution with no new lesions during 4-month follow-up. Antifungal susceptibility showed lowest MIC with fosmanogepix (0.001 mg/L) and terbinafine (0.016 mg/L).

Conclusion

Complete surgical excision combined with short-course antifungal therapy may be sufficient for localized deep cutaneous C. boppii infections, aligning with ESCMID and ECMM clinical guidelines. Prolonged antifungal therapy may not be necessary and could reduce adverse effects associated with pharmacological treatment.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: 10.1016/j.mmcr.2025.100717; PMID: 40697728
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